Living Valve Surgery Delivers Durable Outcomes for Aortic Valve Disease

Aortic valve disease can lead to heart failure, impaired quality of life, and early mortality if untreated, yet standard replacement options often require trade-offs among durability, anticoagulation, and reintervention risk. Selecting the best operation is especially challenging for adults over 50 and patients with aortic regurgitation. To help address these challenges, clinicians have reported contemporary adult outcomes with the Ross Procedure, showing excellent long-term performance when performed in experienced centers.

Mount Sinai Health System (New York, NY, USA) evaluated the Ross Procedure and reported results in the Journal of the American College of Cardiology. The investigation, led from the Icahn School of Medicine at Mount Sinai, represents the largest North American cohort to date and establishes a modern benchmark for this operation. The findings reflect outcomes achievable with a tailored surgical technique and comprehensive program at a high-volume center.

The Ross Procedure replaces the diseased aortic valve with the patient’s own pulmonary valve, creating a living autologous valve in the aortic position. The autograft adapts and replicates native aortic valve hemodynamics, which may support long-term durability. In contrast, mechanical valves require lifelong anticoagulation, and biological valves avoid anticoagulation but tend to degenerate over time, particularly in younger adults.

Investigators followed 455 adults who underwent the Ross Procedure between 2011 and 2019, all performed by the same Mount Sinai surgical team. Patients were enrolled in a dedicated follow-up program with regular clinical evaluations and annual echocardiograms. The mean age was 48 years; half were older than 50 years, 10% were older than 60 years, and the oldest patient was 67 years.

At 12 years, survival matched that of the general population. More than 96% of patients avoided any cardiac reintervention, and over 98% had no significant aortic valve dysfunction. Fewer than 1% required permanent pacemaker implantation, no patients experienced patient–prosthesis mismatch, and there were no cases of aortic valve endocarditis. Among the 3.5% who required additional intervention within 12 years, most were treated with minimally invasive transcatheter techniques rather than repeat open-heart surgery.

Outcomes were comparable in patients with aortic stenosis and those with aortic regurgitation at 12 years, supporting consideration of the procedure across a broader spectrum of valve pathology when a tailored approach is used. Results were also similar in adults older than 50 years. The authors emphasized that performance depends on surgeon experience, institutional expertise, and specialized postoperative management.

“This comprehensive longitudinal study highlights the unique advantages of the Ross Procedure in adults, including outstanding valve durability and excellent long-term clinical outcomes. Importantly, our findings challenge longstanding assumptions by demonstrating excellent results in patient groups that have historically been overlooked,” said Ismail El-Hamamsy, MD, Randall B. Griepp, MD Professor of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai.

“Additionally, our findings showed similar outcomes in patients older than 50, challenging the traditional paradigm of routine use of tissue or mechanical valves in this age group. The combination of excellent durability, restored survival and normal quality of life is driving renewed consideration for the Ross Procedure in older adults,” said Dr. El-Hamamsy.

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Icahn School of Medicine at Mount Sinai